﻿<ul class="accordeon-tabs accordeon-2">
    <li class="open">
        <span class="panel">
        <div class="row">
            <label for="text1">Policy #:</label>
            <input class="text" type="text" id="txt1" name="txt1" value="" />
        </div>
        <div class="row">
            <label for="text1">Policy Renewal Date (X-Date):</label>
            <input class="text" type="text" id="txt2" name="txt2" value="" />
        </div>
        <div class="row">
            <label for="text1">Disable Automatic Emails:</label>
            <div class="groupinput"><input type="checkbox" id="check12" /></div>
                          
        </div>                        
        </span>
    </li>
    <li class="open">
        <span class="tab">
        <span>Contact Information</span>
        <span class="expander"></span>
        </span>
        <span class="panel">
        <div class="row">
            <label for="text1">First Name:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">Last Name:</label>
            <input class="text" type="text" id="text1" />
        </div>
        <div class="row">
            <label for="text1">Evening/Home Phone:</label>
            <input class="text" type="text" />
            <span class="help">
            <span class="phone icon"></span>
            <a href="#">Dial</a>
            </span>
        </div>
        <div class="row">
            <label for="text1">Day/Work Phone:</label>
            <input class="text" type="text" />
            <span class="help">
            <span class="phone icon"></span>
            <a href="#">Dial</a>
            </span>
        </div>
        <div class="row">
            <label for="text1">Cell Phone:</label>
            <input class="text" type="text" />
            <span class="help">
            <span class="phone icon"></span>
            <a href="#">Dial</a>
            </span>
        </div>
        <div class="row">
            <label for="text1">Best Time to Call:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">Preferred Response Time:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">Email:</label>
            <input class="text" type="text" />
            <span class="help">
            <span class="mail icon"></span>
            <a href="#">Dial</a> |
            <a href="#">Opt-Out</a>
            </span>
        </div>
        <div class="row">
            <label for="text1">Fax:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">SMS Phone:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">SMS Opt-Out:</label>
            <div class="groupinput"><input type="checkbox" /></div>
        </div>
        </span>
    </li>
    <li class="open">
        <span class="tab">
        <span>Address Information</span>
        <span class="expander"></span>
        </span>
        <span class="panel">
        <div class="row">
            <label for="text1">Address 1:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">Address 2:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">City:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">County:</label>
            <input class="text" type="text" />
        </div>
        <div class="row">
            <label for="text1">State:</label>
            <div class="select-holder">
                <select id="select3" name="select3" class="select">
                    <option>Select State</option>
                </select>
            </div>
        </div>
        <div class="row">
            <label for="text1">Zip Code:</label>
            <input class="text" type="text" />
        </div>
        </span>
    </li>
</ul>